Thought Disorder Medical and Environmental language Disorder

18 accepted the first of the three alternatives, namely that a good typist is transcribing a deviant script. The patient is correctly reporting a set of disordered thoughts. As Critchley put it: ‘Any considerable aberration of thought or personality will be mirrored in the various levels of articulate speech – phonetic, phonemic, semantic, syntactic and pragmatic’. The language is a mirror of the thought Oyebode, 2008: 175. The script is likened to thought and the typist to language. Most clinicians have taken the view that language closely mirrors thought and see the primary abnormality as the thinking disorder Beveridge, 1985. Disordered language is then seen as merely a reflection of this underlying disturbance, with diagnosis of thought disorder only possible on the basis of what the patient says. Chaer 2009: 160 said that most of people represent their personality through the language they used. Verbal expression is a representation of thought. Therefore, language is a representation of one’s thought. And he concluded that impaired verbal expression as a result of an impaired thought. Language disorder due to thought disorder can be found in dementia, schizophrenia and depressive. 1 Dementia Cummings 2014: 60 said that the dementias are a large and varied group of neuropathologies that lead eventually to the loss of cognitive and physical functions in affected individuals. People with dementia may experience mild cognitive impairment initially which develops over time into mutism, incontinence, immobility and dependence on others for all aspects of care. 19 Dementias can be caused by infections e.g. HIV infection, excessive alcohol consumption over an extended period of time e.g. Korsakoff’s syndrome, cerebrovascular disease e.g. vascular dementia and age-related degenerative changes in the brain e.g. Alzheimer’s disease. Kaplan Sadock, 2007: 329 defined dementia as a progressive impairment of cognitive functions occurring in clear consciousness i.e., in the absence of delirium. Dementia consists of a variety of symptoms that suggest chronic and widespread dysfunction. Global impairment of intellect is the essential feature, manifested as difficulty with memory, attention, thinking, and comprehension. Other mental functions can often be affected, including mood, personality, judgment, and social behavior. Although specific diagnostic criteria are found for various dementias, such as Alzheimers disease or vascular dementia, all dementias have certain common elements that result in significant impairment in social or occupational functioning and cause a significant decline from a previous level of functioning. Dr. Martina Wiwie S. Masun said that dementia is a deteriorating of degradation of memory function or ability to remember and other cognitive ability. This cognitive disturbance in dementia include impaired short-term memory, inability to recognized place, people, and time as well as impaired in language fluency Chaer, 2009: 159. Dementia can be occurs due to a great number of damage to the function of the brain, including degradation of chemical fluid in the brain. Language of 20 individual with dementia was characterized by inability to find appropriate words. They also often utter same sentence for several times. Conversation often disrupted because they forget the topic. It makes their speech incoherent Chaer, 2009: 159. From definition and explanation above it can be said that language disorder in dementia is an acquired language impairment due to degradation of cognitive and memory function because the factors of aging. The characteristic of language in dementia are influent speech, repetition, and incoherent topic. 2 Depressive People with depression can be recognized through their language use. It is because a depressed people often project their depression through their language style and language content. They often speak with very slow sound and the fluency of their speech often disrupted for a long interval. However, their thoughts are not impaired. Their speech often disrupted when they take a breath. The characteristics of depressive speech are the topic often consist of sorrow, they often curse themselves, loss of interest in live and doing activities, unable to enjoy their life, and they tend to end their live by doing suicide Chaer, 2009: 161. 3 Schizophrenia Schizophrenia is one of the most serious and common psychotic disorders. Its name derives from the Greek meaning “split Mind” William, 2014: 2. Kaplan and Sadock 2007: 467 said that schizophrenia is a clinical syndrome of variable, 21 but profoundly disruptive, psychopathology that involves cognition, emotion, perception, and other aspects of behavior. The cause of schizophrenia remains unknown Kaplan Sadock, 1998. It was suggested that several factors could play a role in the etiology of schizophrenia. Among these are genetic, biological, and environmental factors Williams, 2006: 1. The first signs of schizophrenia usually occur during adolescence and early adulthood. Often the effects of the disease are confusing and upsetting family and friends. People with schizophrenia have difficulty in articulating thoughts. This condition leads them to have hallucinations, delusions, disjointed thoughts and behaviors, and unusual speech William, 2012: 2. Because of these symptoms, people suffering from this disease have serious difficulty interacting with others and tend to isolate themselves from the outside world. In order to simplify diagnosis of schizophrenia, schizophrenia symptoms were classified into two categories, known as positive and negative symptoms. According to Kuperberg 2010: 577 positive symptoms of schizophrenia are characterized by an excess or distortion of normal function. They include hallucination most often, verbal auditory hallucination, delusion fixed false beliefs, out of keeping with cultural norms, and held against all evidence to the contrary, and positive thought disorder disorganized language output. Negative symptoms describe the absence of characteristics that normally appear on healthy individuals. They include a lack of voluntary behavior, or lack of motivation, 22 apathy, flat or inappropriate affect, and negative thought disorder poverty of speech and language. Kuperberg 2010: 576 said that symptoms of schizophrenia reflect abnormalities in multiple aspects of human thought, language and communication. Delusion and hallucination in schizophrenia make people with schizophrenia may hear voices other people don’t hear, or see things that other don’t see. They also may believe other people ore reading their minds, controlling their thoughts, or plotting to harm them. People with schizophrenia may sit for hours without moving or talking. Kuperberg and Caplan 2003: 444 stated that abnormalities in language are the central of psychosis, particularly the schizophrenic syndrome. Many, though not all, patients diagnosed with schizophrenia display abnormalities of language. These abnormalities are highly variable and often hard to characterize. It is often unclear whether they reflect deficits in language itself or in related cognitive processes such as planning, execution, and memory Covington et al., 2005: 86. Chaer 2009: 160 called language disorder in schizophrenia as “sisofrenik”. He said that sisofrenik is language disorder due to thought disorder.

2.3 Schizophrenia Speech

Many of the general signs of psychiatric problems can be observed in speech. In fact, oral language is a particularly sensitive manifestation of thought processes and brain dysfunction. Andreasen 1979 : 1318- 1321 proposed 18 types of schizophrenic speech. Those 18 types of schizophrenic speech are: 23 poverty of speech, poverty of content of speech, pressure of speech, distractible speech, tangentiality, derailment, incoherence, illogicality, clanging, neologism, word approximations, circumstantiality, loss of goal, perseveration, echolalia, blocking, stilted speech, and self-reference. 1 Poverty of speech poverty of thought, laconic speech Poverty of speech is a restriction in the amount of spontaneous speech, so that replies to questions tend to be brief, concrete and unelaborated. Unprompted additional information is rarely provided. Replies may be monosyllabic, and some questions may be left unanswered altogether. When confronted with this speech pattern, the interviewer may find himherself frequently prompting the patient to encourage elaboration of replies. Example from Andreasen 1979: 1318: Interviewer: “ Do you think there’s a lot of corruption in government?” Patient: “Yeah, seem to be”. Interviewer: Do you think Haldeman and Ehrlichman and Mitchell have been fairly treated?” Patient: “I don’t know”. Interviewer: “Were you working at all before you came to the hospital?” Patient: “No”. Interviewer: “What kind of jobs have you had in the past? Patient: “Oh, some Janitor jobs, painting”. Interviewer: “What kind of work do you do?” Patient: “I don’t. I don’t like any kind of work. That’s silly.” Interviewer: “How far did you go in school?” Patient: “I’m still in 11 th grade.” Interviewer: How old are you? Patient: “Eighteen.”